New study demonstrates no benefit to off-label hand osteoarthritis therapy

Published on 22 February 2018

A drug that is sometimes used as an off-label treatment for osteoarthritis of the hand may not actually provide the presumed benefits, according to new research.

Arthritis Research UK has funded a study from the University of Leeds that calls into question the current practice of offering the drug hydroxychloroquine off-label as a means of pain relief when conventional medication has failed, as the evidence suggests it is likely to be ineffective.

No benefit from off-label therapy Currently, the common first-line treatment for hand osteoarthritis is paracetamol, non-steroidal anti-inflammatory drugs or opioids, but doctors often use hydroxychloroquine as a backup option for patients who experience adverse reactions to initial therapies.

This is despite the fact that hydroxychloroquine is not specifically licensed for this condition, and that no comprehensive research has been done into whether it is actually effective in these cases. As such, this new study aimed to analyse the drug's performance among 248 patients attending 13 NHS hospitals in England.

Data published in the Annals of Internal Medicine showed that patients initially reported a small reduction in the severity of pain when receiving hydroxychloroquine, but this improvement soon plateaued, with any benefits being no more pronounced than when a placebo was used. Measurements of grip strength and structural damage delivered similar results.

Do current medical practices need to change? Hydroxychloroquine is known to target inflammation and has been proven effective as a treatment for rheumatoid arthritis, which is why doctors have often used it to treat osteoarthritis, where inflammation is a factor.

However, this new study indicates that this method offers no real advantage in terms of controlling symptoms and pain, meaning new options may be needed.

Lead researcher Dr Sarah Kingsbury, from the University of Leeds and the NIHR Leeds Biomedical Research Centre at Chapel Allerton Hospital, said: "Until now, there has not been a large-scale study into whether using hydroxychloroquine works. And our evidence shows that for most patients it is not an effective treatment."

Arthritis Research UK's view Dr Natalie Carter, head of research liaison and evaluation at Arthritis Research UK, said: "While this drug is known to be effective for some forms of inflammatory arthritis, such as rheumatoid arthritis, this study does not back up its use for hand osteoarthritis.

"Hand osteoarthritis can have a huge impact on a person's life, limiting their ability to live independently and carry out everyday tasks such as dressing, washing and cooking for themselves.

"It is vital that we invest in research to improve the treatment options available to people with this condition. Anyone concerned about the effectiveness of their treatment should seek advice from their doctor."

For more information, go to www.arthritisresearchuk.org.Arthritis Research UK fund research into the cause, treatment and cure of arthritis. You can support Arthritis Research UK by volunteering, donating or visiting our shops.